| NPI | 1184669301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES K BAZEMORE President 912-356-5171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 037953) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 15425) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA R039856) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC R00079381) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2009-12-16 |